MEDICARE: JENNIFER VITALE CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	209007942	IL

General Provider Information

NPI Number	:	1780914465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER VITALE CRNA

Provider Business Mailing Address
First Line	:	116 PRESIDENTIAL BLVD
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-9816
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2540 HANFORD LN
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60502-6969
Country	:	US
Telephone Number	:	815-748-8993
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2010
Last Update Date	:	01/02/2010

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